Quadriceps Contusion

The play called for Will, the team's wide receiver, to catch the ball out in the flat, where he could use his speed to get by the man covering him. This time, however, the other team's cornerback read the play perfectly and got a clean shot at Will, driving his shoulder pad into Will's right thigh. Will felt a sharp pain that continued as he lay on the ground after the play, and he needed his teammates to help him off the field.

After the game, Will was still having trouble walking properly and his thigh still hurt. His dad took him to the emergency room, where the doctor told Will he had a grade 2 quadriceps contusion and would be out of action for a couple of weeks.

What Is a Quadriceps Contusion?

Your quadriceps are muscles at the front of your leg that help flex your hip and straighten your knee when you walk or run. These muscles are attached to your femur, or thighbone, so a direct blow to the thigh can crush them against the bone. The resulting injury can be quite painful and, in some cases, serious.

The two types of quadriceps contusion are:

An intramuscular contusion, which is when a muscle tears within the sheath (lining) that surrounds it.

An intermuscular contusion, which happens when the muscle and the sheath surrounding it both tear.

Quadriceps contusions are common in sports that involve a lot of direct contact, such as football and hockey. They're also a risk in sports where there's a chance of collisions, like soccer and lacrosse. And they can happen in sports like skateboarding, skiing, and snowboarding, where there is a chance your thigh might strike an object if you wipe out.

What Are the Symptoms?

You'll know immediately if you get a quadriceps contusion. They hurt a lot. But you won't be able to tell right away how severe it is — and knowing that helps you get the right treatment.

Doctors give quadriceps contusions a grade from 1-3 depending on how serious they are. Each grade has its own symptoms:

Grade 1. This level of contusion will be mildly painful and only slightly tender to the touch. There may be small amounts of bruising and swelling. You should be able to walk normally and bend your knee more than 90 degrees.

Grade 2. You may see more swelling and possibly deeper bruising in your thigh, and you'll probably be walking with a limp. The affected area will be tender and you'll only be able to bend your knee between 45 and 90 degrees.

Grade 3. Your thigh will be swollen and painful and might be deeply bruised, and you will have trouble bending your knee and walking without crutches. The range of motion of your knee will be less than 45 degrees and there may be a bulge in your muscle when you try to straighten your leg.

It's good to get your injury checked by a doctor, even if you feel sure you have mild quadriceps contusion. That's because a quadriceps contusion can sometimes lead to other problems:

Myositis ossificans is a serious condition that happens when bone starts to form within the muscle. It's not a common problem, but it is one that's best detected early on: The longer it goes on, the more problems it can cause.

Compartment syndrome is another rare but serious complication of quadriceps contusions. In compartment syndrome, bleeding from the damaged muscle can get trapped and build up within the muscle sheath (the layer of tissue that wraps around the muscle). As blood builds up within this space, the muscles get squeezed and oxygen can't get to the blood vessels, tissues, and nerves. That can lead to permanent muscle damage. If you feel pain that's even worse than the pain you had when you injured yourself, or if you feel tingling or burning in the area you injured, call a doctor right away.

What Do Doctors Do?

If a doctor thinks you have a quadriceps contusion, he or she will check to see which type it is (intramuscular or intermuscular) as well as what grade.

The doctor will examine your thigh and may press on it or massage it to see how tender it is. The doctor will ask what happened to cause the injury and what symptoms you're feeling. You'll probably also be asked to bend your knee to see if your range of motion is limited.

If the injury seems serious or doesn't get better after treatment for a few weeks, the doctor may call for an MRI scan to determine the extent of the tear and check for other problems.

What Causes a Quadriceps Contusion?

If you get a quadriceps contusion, there'll be no mistaking the cause. Something ― a football helmet, another player's knee, a railing at a skatepark ― will hit you very hard in the leg. This is why quadriceps contusions are common in sports that involve contact or the potential for a collision.

If the impact crushes your muscles against your thighbone (femur), they can start to tear and bleed. That can cause pain and swelling. If the injury is an intramuscular contusion, where the bleeding is contained within the muscle sheath, you might not notice much bruising at first. But if the sheath tears along with the muscle (intermuscular contusion), it can cause considerable bruising and discoloration in your thigh.

Can I Prevent a Quadriceps Contusion?

It can be hard to prevent a quadriceps contusion, since they happen suddenly and can be difficult to see coming.

But you can make this type of injury less likely by following a few simple guidelines when you play sports:

Wear protective gear that fits correctly. Hockey and football require pants that should have thigh pads. Make sure you wear them and they're properly fitted to you so the pads are in the right place.

Know the rules of your sport and follow them. In a football game, you wouldn't want someone to ram his helmet into your thigh (a penalty called spearing), so make sure you don't do it to an opposing player.

With skiing, snowboarding, and skateboarding, know your limits. Stay within your capabilities to decrease the risk of a hard fall that might bring your thigh into contact with a railing, park feature, or tree.

Treating a Quadriceps Contusion

Grade 1 contusions will require little more than rest and some gentle stretching to heal, and they won't be much of a problem. Grade 2 and 3 contusions will probably require more treatment. If you have pain, ask your doctor about which pain relievers you can take.

Some of the things you can do to treat a quadriceps contusion include:

Use the RICE formula:

Rest. Limit your physical activity and use your thigh muscles as little as possible. If putting weight on your injured leg is painful, you'll want to use crutches when you walk.

Ice. Use a bag of ice or a cold compress to help reduce swelling. This should be done as soon as possible after the injury and while keeping your knee slightly bent to help the healing process. Ice for 20 minutes every 2-3 hours.

Compress. Use bandages or wraps to help support your thigh and keep the swelling down. If possible, try to do this with your knee fully bent as soon as you can after the injury. Have someone wrap your thigh and calf together to immobilize your knee in a bent position for the first 24 hours.

Elevate. If you are lying down, put pillows under your leg to elevate your thigh and put your knee in a slightly bent position.

Do not apply heat to the affected area. Using heat to treat a quadriceps contusion can increase the amount of swelling and may be a contributing cause to myositis ossificans.

Make careful use of massage. Having a sports injury professional massage your leg when your injury is in its later stages can help you recover flexibility and range of motion. However, massaging a newly injured quadriceps can increase the likelihood of myositis ossificans.

Follow a prescribed physical therapy program. Once the pain and swelling have gone down, talk to your doctor about a rehabilitation program that will help you recover strength and flexibility in your leg as it heals.

Return to activity and sports slowly. Try to keep your weight off your injured leg until you can do so without pain. This includes walking with crutches until you can walk normally without them. Trying to exercise on a badly torn muscle can make recovery more difficult. Don't resume sports until you are completely pain free or have been cleared by a doctor to start playing again.

Call your doctor right away if you notice these signs of compartment syndrome:

pain that's even worse than the pain you had when you were injured

tingling or burning in the area where the injury happened

A few people may need surgery to fix a quadriceps contusion. Surgery is rare, but it might be needed if there's a complete muscle tear or if a quadriceps contusion doesn't heal properly. Doctors also may recommend surgery if myositis ossificans affects a person's range of motion or irritates nerves or veins.

If you get a quadriceps contusion, you'll most likely go back to your normal activities after a few weeks of rest. But because of the possible complications, a quadriceps contusion isn't something you want to mess with. Be sure a doctor clears you to play before you start getting active again.